Trust me I’m a PR expert. Is it right for health comms to nudge?

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Ann is a co-founder of PR Academy. Her special areas of interest are internal communication, change management and project communication. MSc, Dip CAM, MCIPR

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CIPR Advanced Certificate graduate, Nicollen Meek, writes about the ethical implications of using nudge as a way to deliver a health communications campaign. It is based on her final course assignment – her critique – that you can read in full here.*

The NHS provides an invaluable service to millions across the UK, but with rising patient demand, improving public health is one way the government and health organisations can relieve the burden.

It’s also no secret that for the NHS, money is a growing concern and so health communication campaigns are increasingly seen not just as a way to improve people’s lives but also to help cut costs.

Everyone can think of a public heath campaign like Smokefree or Give Blood where they’re reminded of the risks or benefits of making small but significant changes to their lifestyles. But what if you’re a local hospital or GP practice, which doesn’t have access to the resources needed to create sweeping media campaigns? How can you reach your audience and make an impact?

One way could be to apply methods based on behavioural economics. This is a theory based on the concept that when you understand how social, cognitive and emotional factors influence the economic decisions of your audience, you are better able to present them with choices they are more likely to accept. One example of this is ‘nudge’.

To nudge means making “simple changes in the presentation of choice alternatives that make the desired choice the easy, automatic or default choice”. By understanding the environment and triggers of individual’s decision, a health communicator can begin to see how it can influence their audiences’ behaviour.

A small but effective example was increasing the accessibility of hand sanitizers for visitors, staff and patients in healthcare settings. Sanitizers are now placed by entrances, exits, reception desks and waiting rooms to act as non-intrusive, but visual cues, to sanitize your hand and thus reduce infection risks.

Coined by Thaler and Sunstein to describe how simple behavioural psychology could be used to improve decision making outcomes, the ‘nudge’ has proven to be useful but has also reached infamous heights in the PR world.

By employing techniques like this, practitioners run the risk of being so focused on improving lives that they infringe on the freedoms of the individual.

The truth is that the questions surrounding the ethics of behavioural economics still remain in health communications.

Before even starting to figure out what makes an audience tick, the nudger is working from a position where they know what they want their audience to do and everything after that is information to prepare for this desired outcome.

Arguably, by presenting a choice that’s easier and a better alternative to other choices, the nudger has already manipulated the outcome. They have ‘architected’ a scenario where a person will perform a task or make a decision not because of their will to do so, but because the other choices have been made to look so much worse. Even if you could guarantee every nudge will always benefit the audience, it can still fall short.

Could it really be good ethical practice to covertly take away a person’s right to make any decisions, whether it’s bad for their health or not?

The NHS, as a public body, has a duty not to infringe on the public’s freedom of choice. Isn’t it a person’s right to be able to decide if they want a sugary snack or a healthy one?

However when it comes to public health, the government also has a responsibility to protect the wellbeing of their citizens. The NHS is under increasing strain to help a growing number of patients with increasingly complex needs, so finding small ways to encourage people to remember to wash their hands, or smoke fewer cigarettes can benefit everyone. When used appropriately, a nudge has the potential to make positive changes to people’s lives.

The challenge will be to understand the extent to which you can influence a person and without greatly impacting their freedom. But that’s a judgement call for any one working in PR.

CIPR’s Ethics Festival reminds us all that by acting with the upmost professionalism and demonstrating ethical competence and understanding we can provide an exceptional service to our employers, and ultimately our stakeholders.

*The CIPR Advanced Certificate is now the Professional PR Certificate with a refreshed syllabus and new assignments.